Splenectomy and proximal lieno-renal shunt in a factor five deficient patient with extra-hepatic portal vein obstruction

Successful laparoscopic common bile duct exploration in a patient with factor V deficiency, a case report and review of literature

Factor V deficiency is a rare bleeding disorder. Fresh frozen plasma (FFP) is the only source of factor V because factor V concentrates is not available now. We present here a patient had concomitant gallbladder and common bile (CBD) stones with factor V deficiency. The patient is successfully treated by laparoscopic CBD exploration and cholecystectomy with perioperative fresh frozen plasma transfusion. To best of our knowledge, this is the first report of laparoscopic surgery successfully performed in a factor V deficiency patient. Our result suggest that laparoscopic surgery in a factor V deficient patient can be performed safely if normal coagulation profile is achieved after injection of FFP. Our experience in this case also indicate that the incidence of delayed bleeding after surgery is low once hemostasis is successfully obtained during operation and there is no need to continue FFP infusion beyond day 2 postoperative.

Hepatic veno-occlusive disease followed by esophageal varix rupture after hematopoietic stem cell transplantation in a 4-year-old boy with stage 4 neuroblastoma

Hepatic veno-occlusive disease (HVOD) is one of the major potential complications associated with high-dose chemotherapy with stem cell transplantation in children. However, esophageal varix rupture after HVOD has, to our knowledge, never been reported before. Here we report a case of a 4-year-old boy with stage 4 neuroblastoma with potentially fatal HVOD followed by esophageal varix rupture and massive intestinal bleeding after high-dose chemotherapy with autologous peripheral blood stem cell transplantation. We successfully treated him by endoscopic variceal ligation and administration of somatostatin analog.